Acute Ischemic Stroke Among Cannabis Users in the United States and Possible Risk Factors for Mortality

Abstract

Background: With changes in state laws, cannabis is now more accessible in many parts of the United States. The drug has previously been associated with a higher incidence of acute ischemic stroke (AIS). Our study analyzed the effect of cannabis use on AIS outcomes. Methods: The 2019 National Inpatient Sample from Healthcare Cost and Utilization Project and Agency for Healthcare Research and Quality was used to evaluate the AIS patients ages 25 and more. Cannabis users were compared with nonusers. Their mortality risks were also assessed. Results: Five hundred thirty-nine thousand eight hundred eighty patients with AIS were in our study and 8850 used cannabis. Among the cannabis users with AIS, 69.8% were males, 50.6% were white, 61.8% were aged 46 to 65, 32.1% used Medicaid, 86.1% were nonobese, 72.0% were nondiabetics, 81.7% had hypertension, 80.7% did not have a history of alcohol abuse, and 77.5% were smokers (nicotine). Only 12.8% of cannabis users reported any cardiac dysrhythmia, whereas 5.4% required mechanical thrombectomy, and 8.0% received intravenous tissue plasminogen activator (tPA). After adjusting the variables, cannabis users covered by Medicare, with diabetes, a history of alcohol abuse, cardiac dysrhythmias, and who underwent mechanical thrombectomy had a higher risk of dying. The overall adjusted odds ratio of dying among cannabis users with AIS was 0.603 (95% CI, 0.504-0.722, P<0.01). Conclusions: Although the overall mortality risk seems to be lower among cannabis users, those with certain risk factors still present higher mortality risks. Patients with cannabis use should therefore be monitored closely for possible complications and mortality after AIS.

Unmasking the cannabis paradox: in-hospital outcomes of cannabis users admitted with acute myocardial infarction over a 20-year period in the United States

“…Tobacco smoking has also been linked with cannabis dependence [ 39 , 40 ]. While prior studies observed a lower obesity rate among cannabis users admitted for ischaemic stroke or myocardial infarction, our sample had a higher proportion of cannabis users classified as obese [ 30 , 41 , 42 ]. Importantly, even after propensity matching and adjusting for these potential confounders, cannabis use continued to be associated with a survival benefit in AMI.…”

“…Our sample consisted of hospitalisations with a primary diagnosis of AMI via ICD-9 and ICD-10 codes from past studies. All cases that qualified as “Drug Abuse” based on ICD-9 and ICD-10 codes were excluded from our control group [ 30 ]. We studied the prevalence of multiple comorbidities as well as patient and hospital characteristics between cannabis users and non-users.…”

Five-year trends in risk factors for cardiovascular disease among adolescents in the United States

“…Since the ICD-10 code for prediabetes was introduced in 2016, and it did not cover all the months of that particular year, we focused on the 2017–2020 data for our prediabetes group. We also estimated the incidence of acute myocardial infarction (AMI) and acute ischemic stroke (AIS) over these 5 years [ 10 , 11 ]. Linear-by-linear analyses, as per past studies of the NIS, were used to estimate trends [ 12 ].…”